Provider Demographics
NPI:1760604219
Name:ALL ABOUT TEETH
Entity Type:Organization
Organization Name:ALL ABOUT TEETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS
Authorized Official - Phone:505-756-2901
Mailing Address - Street 1:211 N PINE
Mailing Address - Street 2:P O BOX 1186
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520
Mailing Address - Country:US
Mailing Address - Phone:505-756-2901
Mailing Address - Fax:
Practice Address - Street 1:211 NORTH PINE
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520
Practice Address - Country:US
Practice Address - Phone:505-756-2901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH 1522124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1598755076Medicare UPIN
NM1710006002Medicare UPIN